Provider Demographics
NPI:1720034804
Name:GRAHAM, CHESTER F (MD)
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:F
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 360
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:214-691-1902
Practice Address - Fax:214-987-1845
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105340701Medicaid
TX340016191OtherRRMCR
80420XOtherBCBS PROVIDER ID
TX105340702Medicaid
TX340016186OtherRRMCR OTHER
TX105340702Medicaid
TX105340701Medicaid
TX87065KMedicare PIN